The Dental Kit
In the next 10 pages, there are lists of medicines, instruments, and other supplies recommended in this book. Keep them together in a kit. You may want to change some of them, or add others to meet your own needs.
As a dental worker, you will be able to get many of the items on the lists from your government medical stores. Some things you will have to buy yourself. That can be expensive, so we make several suggestions to help you save money.
Before you order, decide how many of each thing you need. Ask yourself: How many persons do I treat each day? For what problems? Then order enough medicines and supplies for three months. Note: as more people learn about the treatment you can give, more will come to ask for your help. Remember this when you order. Remember, also, that some persons may need more than one treatment.
We recommend how many medicines, supplies, and instruments you will need if you see 10 people a day - 200 a month. You cannot be exact, of course, because you cannot predict exactly what problems will arise. However, we can say that, on the average:
In a group of 10 persons with urgent problems:
Another antibiotic, tetracycline, is not recommended for any of the treatments in this book because it is a broad-spectrum antibiotic. Narrow-spectrum antibiotics (see ‘antibiotics’) are usually safer and just as effective for most dental problems. If you do use tetracycline, read Where There Is No Doctor and remember, do not give tetracycline to a pregnant woman or to a young child. Tetracycline can make a young, developing tooth turn yellow.
Before you give medicine, think about the sick person’s weight and age. The smaller children are, the less medicine they need. For example, pain medicine like aspirin (300 mg tablets) or acetaminophen (500 mg tablets) can be broken up into smaller tablets:
Antibiotics kill bacteria that cause infections. Some antibiotics work better than others on certain bacteria. If you can, test the pus to find which antibiotic works best.
Do not give penicillin to a person who is allergic to it. Ask about the person’s allergies before you give penicillin pills or injections. When you inject penicillin, always keep epinephrine (Adrenalin) ready to inject if the person shows signs of allergic shock. Stay with the person for 30 minutes. If you see these signs ...
... immediately inject epinephrine: 1/2 ml for adults or 1/4 ml for children. For more information on allergic shock, see Where There Is No Doctor.
Always give the full dose of penicillin or any antibiotic, even if the person feels better. Erythromycin also comes in liquid form. It has 125 mg in 5 ml, so 10 ml of liquid (about two large teaspoons) is the same as one tablet.
It is important to take a strong first dose of penicillin or erythromycin, and then smaller doses four times a day for 3 to 5 days after that.
INJECTIONS: FOR SEVERE INFECTIONS
It is always safer to take medicine by mouth. Sometimes, however, an infection is so bad that you need to give medicine by injection. Learn how to give injections from an experienced health worker. The injections described on this page are not like the anesthetic injections in Chapter 9 of this book - you must inject these medicines into a large muscle in the buttocks or arm. For more instructions on this kind of injection, see Chapter 9 of Where There Is No Doctor.
For severe infection: There are two kinds of penicillin to inject.
You can use a solution of fluoride and water (above, number 5) in two ways:
If you order your supplies in bulk long before you need them, you probably will pay lower prices. If you have a place to store supplies that is clean, dry, and free from cockroaches and rats, consider ordering enough for one year instead of only 3 months.
When you are treating several people on the same day, you will need to clean some instruments at the same time that you are using others. Therefore, it is necessary to have several of each kind of instrument, to be sure that the instrument you need will be ready (clean or sterile) when you need it.
There are three instruments you will need for each person who comes to you, no matter which treatment is needed. They are: a mirror, probe, and cotton pliers. Keep them together. Below we recommend that you have 15 of each of these, so you can keep one in each treatment kit. You do not need to buy all of these instruments. You can make several of them - see Making your own dental instruments. If you like, buy only one example of each of the instruments below, and use them as models to copy when you make your own extra instruments.*
MAKING YOUR OWN DENTAL INSTRUMENTS*
Can you think of any other materials you can use?
Each instrument has two parts: a handle and a working piece at the end. Join them together:
If you make the end flat, it can prevent the working piece from turning. Pound the working piece with a hammer and make a flat slot in the handle so the working piece cannot turn.
Making the Three Instruments You Use Most
Mirror: Use old pieces of mirror or a shiny piece of tin. You even can use a polished silver coin. A tongue depressor is the handle.
Probe: Use the end of a paper clip, pin or needle for the working piece. Rub it against a smooth stone to sharpen it. Bend it so it can reach around to the back of a tooth. Attach the working piece to a smooth stick handle.
Tweezers: Draw the shape on a piece of tin and then cut it out with strong scissors. Use a file or a smooth stone to make the edges smooth. Bend in half to make the tweezers.
Making Other Instruments and Supplies
Spoon: Bend a paper clip or needle. Flatten the end. Then pound a small stone against the end, to make it hollow. Make 2 bends and attach to a stick handle.
Filling Tool: Remove the heads from 2 long screws.
With a file and hammer, make the end of one screw flat and the end of the other screw round.
Bend each end in the direction of the edge (not the face) of the flat side.
Attach both working pieces to a small stick handle.
Dental Floss: When using string to clean between your teeth, you may have trouble getting this string down in between your teeth. Sometimes, also, the string gets caught there, forming a kind of ‘bird’s nest’. Three things can cause problems with dental floss:
1. An incorrectly made filling - flat and rough instead of round and smooth. Replace it.
2. Teeth too tight together. Use the floss on a tooth. Then pull the string out from between the teeth as you press the free end down against the gum with the fingers of your other hand. If there is a sharp filling on a tooth, the string will stay under it as it comes free.
3. String that is too thick. Make thinner but stronger floss by waxing as in this picture. The wax also will make the floss easier to slide between your teeth.
Buying Dental Instruments
When you do not have much money, you must spend wisely. Dental instruments are very expensive, especially when you buy them at commercial prices. You may want help to find the lowest prices available to you.
The Dental Health Services Unit of AHRTAG (AHRTAG means Appropriate Health Resources and Technologies Action Group Ltd.) may be able to help. Write to them and tell them what you are doing and what you need. AHRTAG can use the information to develop the right kind of projects in other countries. In return, AHRTAG possibly can give you good advice to help you buy or make your own low-cost dental equipment. Their address is:
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